WHO operational handbook on tuberculosis Module 3: Diagnosis - Rapid diagnostics for tuberculosis detection. Web Annex C. Technical manual for culture-based drug susceptibility testing of anti-tuberculosis drugs used in the treatment of tuberculosis

Background 

In 2022 more than 10 million people fell ill with tuberculosis (TB), including almost half a million with multi-drug or rifampicin-resistant TB (MDR/RR-TB) (1). Only one third of people with MDR/RR-TB were known to have been diagnosed and enrolled on treatment. The number of individuals falling ill with TB that is susceptible to rifampicin but resistant to isoniazid is estimated to be more than two times higher than RR-TB and remains largely undetected and inadequately treated (2). Globally, the prevalence of fluoroquinolone (FQ) resistance among MDR/RR-TB is approximately 20%. Recently the World Health Organization (WHO) endorsed the use of a novel all-oral 6-month regimen composed of bedaquiline, pretomanid, linezolid and moxifloxacin (BPaLM) in people suffering from MDR/RR-TB, including those with additional resistance to fluoroquinolones (pre-XDR-TB, BPaL without moxifloxacin).